Bioethics

Economic arguments and assisted dying.

by Dominic Wilkinson (@NeonatalEthics)

Lord Falconer’s assisted dying bill is being debated today in the House of Lords. In the past week or two there has discussion in the media of many of the familiar arguments for and against such a proposal. As Roger Crisp noted in yesterday’s post, there have been relatively few new arguments. Supporters of the bill refer to compassion for the terminally ill, the difficulty of adequately relieving suffering, and patients’ right to make fundamental choices about the last stage of their lives. Opponents of the bill express their compassion for the terminally ill and those with disabilities, fear about coercion, and the omnipresent slippery slope.

One concern that has been raised about the assisted dying bill is the fear of abuse in the setting of an overstretched public health system. For example, Penny Pepper, writing in the Guardian notes that “Cuts to social care are monstrous…How would the enactment of the Falconer bill work if brought to our harassed NHS?”

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Would Legal Assisted Suicide be the Final Triumph of Market Capitalism?

Tomorrow  in the House of Lords Lord Falconer’s bill on assisted dying will be debated. The bill would allow those who are terminally ill and likely to die within six months to request life-ending drugs from their doctor for the patients to use as and when they see fit.

As might have been expected, there has been huge discussion over the bill, but most of the arguments presented so far are not new, and the same will probably be true tomorrow. But there is one I haven’t seen before, put forward recently by Giles Fraser: that assisted suicide is the ‘final triumph of market capitalism’. Continue reading

The pill to banish painful memories—forget it!

It is a curious feature of the late 20th and early 21st centuries that the media regales readers and viewers almost daily with exciting details of breakthroughs in medical science: new cures, reversals of previous certainties about old remedies (and then, often enough, later reversals of the reversals), astonishing information about our brains and numerous other organs, apparently dramatic discoveries about free will and ethical thinking. Much of this is indeed attributable to the rapid rate of the expansion of contemporary scientific understanding which we should not want to underestimate, but it is also sometimes the result of the media’s excitability and search for sensation, combined with the impressive self-promotional skills of practitioners of the medical sciences. This latter factor means that reported “breakthroughs” are often no more than confident early steps on a promising but uncertain path, and when they lead nowhere this sad news tends not to see the light of day. And then there are the cases of outright fraud or incompetence, such as the South Korean scientist Hwang Woo-suk’s initially much-proclaimed breakthroughs in the early 2000s in stem cell research that were shown to be faked.

So a certain reserve about reported breakthroughs is in order, but a recent case is worth philosophical scrutiny even if its claims turn out to be less valid than they seem. This was a report in The Mail Online, Science and Technology section that was headlined “Could Pill wipe out bad memories? Drug used to treat multiple sclerosis found to help us forget experiences that caused us pain.” But it turns out that the drug has only been tested for memory erasure of pain in mice, and then only of a specific type of pain associated with mild electric shock. The Mail article jumps rapidly from this modest beginning to claim that the experiment “offers hope of a drug that could eradicate memories of traumatic events from years ago and help patients overcome phobias, eating disorders and even sexual hang-ups.” For none of this “hope” is there an iota of evidence in the scientific study and one of the scientists involved in the study at the Commonwealth University of Virginia, Dr Sarah Spiegel, showing appropriate modesty, said of the drug concerned: ‘Fingolimod, a Food and Drug Administration approved drug for treatment of multiple sclerosis, has beneficial effects in the central nervous system that are not yet well understood.” More ambitiously she added: “Fingolimod deserves consideration as an adjuvant therapy for post traumatic stress disorder and other anxiety disorders.”

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Quebec legalises assisted-death: should other states follow?

Last month Quebec legalised assisted-death. The new law allows ‘medical aid in dying’ for adults at the end of life who suffer “constant and unbearable physical or psychological pain” as a result of a “serious and incurable illness”. The passage of this law makes Quebec the first jurisdiction in Canada to allow assisted-death or euthanasia.

The Bill follows successful legalisation of assisted-dying just south of Quebec last year in the American state of Vermont. Jurisdictions in which the practice is now legal include the Netherlands, Switzerland, Belgium, Luxembourg, Washington, Montana and Oregon.

Surprisingly, the arguments for and against assisted-death and euthanasia haven’t been discussed all that frequently on this blog. So this post will consider: would legalising assisted-death (patient administered) or voluntary euthanasia (physician administered) provide a compassionate exit to those facing decline and suffering and the means to live and die by our own lights, or involve a repugnant devaluation of human life that would put the vulnerable at risk?

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Horizon 2020 and The Role of Lay People’s Perspectives in Bioethical Reasoning

By Kimberly Schelle & Nadira Faulmüller

Horizon 2020, the European Union’s 2014-2020 largest research programme ever, includes the call to pursue ‘Responsible Research and Innovation’ (RRI). RRI stands for a research and innovation process in which all societal actors (e.g. citizens, policy makers, business and researchers) are working together in the process to align the outcomes with the values, needs, and expectations of the European Society. In a recently published paper on the importance of including the public and patients’ voices in bioethical reasoning, the authors describe, although in other words, the value of the RRI approach in bioethical issues:

“A bioethical position that fails to do this [exchange with the public opinion], and which thus avoids the confrontation with different public arguments, including ones perhaps based in different cultural histories, relations and ontological grounds […], not only runs the risk of missing important aspects, ideas and arguments. It also arouses strong suspicion of being indeed one-sided, biased or ideological—thus illegitimate.”

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Do Not Attempt Resuscitation orders: should you discuss with the patient?

The Court of Appeal has stated that a statement in a capacitous patient’s medical notes that resuscitation should not be attempted (a ‘Do Not Attempt Resuscitation’ Order – DNAR), should usually only be inserted after consultation with the patient: see R (Tracey) v Cambridge University Hospitals NHS Foundation Trust and others [2014] EWCA Civ 822 (17 June 2014).

The facts have been widely aired in the media: see, for example, here.

Mrs. Tracey had terminal lung cancer. Her clinicians indicated in the notes that no attempts at resuscitation should be made. Her family found out about this, and were outraged, saying that the DNAR order should not have been made without consultation with Mrs. Tracey. Their quarrel was not with the medical appropriateness of the determination that resuscitation would not be in Mrs. Tracey’s best interests, but with the procedure  - the failure to consult.  This, they said, violated Mrs. Tracey’s rights under Article 8 of the ECHR.

The Resuscitation Council, intervening, said that a requirement to consult with the patient would interfere with clinicians’ ability to deliver individual and compassionate care. A patient might, for instance, be very distressed by a discussion about a possible DNAR order.

The outcome can be briefly stated:

  • Mrs. Tracey’s Article 8 rights were engaged by recording the DNAR in the notes. This followed from, inter alia, Pretty v UK (2002) 35 EHRR 1.
  • Her Article 8(1) rights were violated by failing to involve her in the process
  • Article 8(2) required the policy adopted by a Trust in relation to DNAR orders to be sufficiently clear and accessible: see Purdy v DPP [2009] UKHL 45; [2010] 1 AC 345.
  • The absence of a mandatory national DNAR policy was not a violation of Article 8. Local policies would, if properly formulated, satisfy the demands of Article 8(2)
  • The concerns of the Resuscitation Council were real, but could be met by an important caveat: there should be consultation with the patient unless the clinician ‘thinks that the patient will be distressed by being consulted and that distress might cause the patient harm.’ Continue reading

Telling porkies

by Dominic Wilkinson (@Neonatalethics)

 

One of my registrars asked an interesting question this morning. A commonly used life-saving medicine in newborn intensive care is derived from animal products; should parents be told?

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Two Tales of Marshmallows and their Implications for Free Will

Patricia Churchland, a prominent Neurophilosopher, just published a book on neuroscience and its ethical implications which led to a rather nasty exchange in the New York Review of Books with fellow philosopher Colin McGinn.  His pointed, to put it mildly, criticism of her work was based on philosophical considerations about the implications neuroscience has, or, as he argues, lacks, for the philosophy of mind. This criticism evoked two sentiments in me. First, I felt a strong sense of hopelessness for a world in which not even two philosophers can engage in a sober, respectful argument about something they disagree on; not even under the tutelage of the editors of the New York Review of Books, one of the so-called sanctuaries of intellectualism. Good luck Palestine and Israel! Thereafter, I remembered the unease I at times felt as a psychologist when hearing or reading about Churchland’s work.

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Essendon, Doping and Bad Arguments

By Julian Savulescu. @juliansavulescu

The Australian newspaper ‘The Sunday Age’ reports today that “The Australian Sports Anti-Doping Authority has built a ”non-presence” drug case against 34 Essendon footballers, adopting a strategy similar to the one used to ban Lance Armstrong without a positive test.”

1. What should we think about this latest drugs “scandal” at Essendon, the so called “war on doping” in the Australian Football League (AFL), and in sport in general?

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Genetically Modifying Mosquitoes to ‘Bite the Dust’? Ethical Considerations

At some point, most people will have questioned the necessity of the existence of mosquitoes. In the UK at least, the things that might prompt us into such reflection are probably trivial; in my own case, the mild irritation of an itchy and unsightly swelling caused by a mosquito bite will normally lead me to rue the existence of these blood-sucking pests. Elsewhere though, mosquitoes lead to problems that are far from trivial; in Africa the Anopheles gambiae mosquito is the major vector of malaria, a disease that is estimated to kill more than 1 million people each year, most of whom are African children. Continue reading

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